The invention relates to an aquatic apparatus and method for a) treatment of patients with neck and back pain, b) rehydrating intervertebral discs, c) mobilizing arthritic and post-operative joints, and d) exercising limbs with neuromuscular impairment, including that caused by strokes.
It is well known to physicians that a significant cause of lower back pain is pinching of nerves due to collapsing of vertebral discs in the lumbar spine, and that the resulting pain could be prevented if a better way could be found to avoid premature dying of intervertebral disc cells. The premature dying of disc surface tissue results in the thinning or collapsing of the cells. The dying of intervertebral disc cells occurs as a result of lack of nourishment. Nourishment of the discs occurs as a result of passive diffusion of nutrient-containing fluids along the upper and lower surfaces of such discs. The nutritional fluids providing the upper and lower disc surfaces with nutrients and water move by passive diffusion along osmotic and hydrostatic gradients in the passages within the vertebral discs and between the adjacent lumbar vertebrae. Consequently, any continually exerted hydrostatic pressure that prevents such passive diffusion also prevents adequate nourishment and hydration of the disc surfaces. This results in premature, unrenewable loss of surface disc cells. In FIG. 1, D designates an intervertebral disc. LV4 designates the fourth lumbar vertebra, LV5 designates the fifth lumbar vertebra, P4 designates the pedicles of L4, L4 designates the lamina of L4, and N4 designates the nerve exiting by L4. S indicates "superior", I indicates "inferior", so SF designates the superior facet, and IF designates the inferior facet. Those skilled in the art know that the thoracic spine includes the thoracic vertebrae commonly designated T1-T12, and the lumbar spine includes the lumbar vertebrae commonly designated L1-L5.
Very shallow spaces 2 and 3 exist above and below disc D, between it and lumbar vertebrae LV4 and LV5. The nutrient fluids and gases must diffuse through spaces 2 and 3 every day to nourish the upper and lower surfaces of disc D if premature dying of disc cells is to be avoided.
If the person is awake and involved in normal activities such as standing or sitting, the weight of the person's upper body compresses the lumbar vertebrae LV4 and LV5 against the upper and lower surfaces of disc D, completely eliminating spaces 2 and 3, effectively sealing off the upper and lower surfaces of disc D from the nutrient fluids. When the person sleeps, spaces 2 and 3 ordinarily will open enough to allow diffusion of the nutrient solution and thereby allow adequate nourishment and hydration of the upper and lower surfaces of disc D, because the sleeping person usually is horizontal and his or her body weight does not compress lumbar vertebrae LV4, disc D, and lumbar vertebrae LV5 enough to completely close off passages 2 and 3 to diffusion of the nutrient fluid.
All of the weight of a person's upper body is transferred through the spine into the sacro-iliac joints, which are designed as a double wedge from the top to bottom and from the front to back. FIGS. 1A and 1B illustrate the normal positional relationship of the ilium 55A,B and the sacrum 56. The dotted lines 56A illustrates how the sacrum 56 can become asymmetrically "wedged" against the right hand portion 55B of the ilium 55A,B as the sacrum 56 moves forward toward the front of the person. This happens when the person subjects the sacrum 56 to asymmetrical force or torque that causes only the right hand portion of sacrum 56 to move forward in the direction of arrow 57, and the "wedging" of portion 55B of the ilium prevents sacrum 56 from returning to its normal position from the position indicated by dotted lines 56A.
FIG. 1B shows a rear view of the sacrum 56 and the ilium 55A,B, wherein the letter X designates space between the interface surfaces at which the "wedging" occurs between sacrum 56 and ilium 55A,B. When the sacrum is wedged into the position indicated by dotted lines 56A in FIG. 1B, lower back pain is the result. Conventional traction techniques attempt to remove the sacrum from the position 56A to the position 56 in FIG. 1B. Mild traction can have the effect of tending to increase the spaces designated by letter X in FIG. 1A, effectively "lifting" the sacrum upward from the ilia enough to avoid the above wedging, allowing the sacrum 56 to move from the dotted lines 56A back to its normal position.
Thus, the sacrum is a double wedge that rests between the iliac crests in a position of highest pain-free mechanical position. The distances of wedging movement are small, yet the pain-inflammation-spasm disability from this wedged joint cannot be relieved. Only by "antiwedging" techniques can this problem be solved.
The sacro-iliac (S-I) joints are very irregular in their surfaces and do not readily return to their original anatomic position once out of normal position. A normal muscle achieves a stretch in 15 seconds. An inflamed, toxic, anaerobic spasm-sustained muscle can relax only after a significantly longer period of time, 15 minutes or greater. All surrounding normal muscles will relax first, and then the lengthy process of spasm-relaxation and unwedging can begin.
It is the experience of many patients that a calf cramp or foot cramp, once relieved, has a propensity for re-spasm shortly after the release spasm prevents joints from going through their full range of motion. Muscles-in-spasm become, in effect, discreet entities which cut off blood, oxygen supply, nourishment and toxin removal. Surrounding muscles which are healthy can stretch sufficiently to "by-pass" a spasm in 15 seconds. If issues of comfort, safety and security are not addressed, adequate relaxation will not occur to allow the spasm to be overcome.
Arthritic and weakened patients often do not have sufficient strength to exercise and move joints through a range of motion because of the influence of gravity, i.e., their body weight. Spasms and continual use of the muscles and joints occurs. To move a lower extremity, the entire lower extremity must be lifted to begin active exercise.
Lower back problems can result from injury and resulting subsequent increased muscular tonicity of muscles, such as those represented by numerals 6 and 7 in FIG. 1, and other large muscle groups which do not appear in the very simplified diagram of FIG. 3. If such muscles become injured, they contract into sustained spasm, preventing spaces 2 and 3 from opening up even when the patient sleeps horizontally. The upper and lower surface tissue of disc D then begins to die, never to be replaced. In FIG. 1 there is a gap designated by arrows 10. Even a millimeter of closure of the gap 10 can result in pinching a portion of a nerve such as N4.
There is a triangular arrangement of three ligament connection points of each vertebrae to the vertebrae above or below it. If force thereon becomes sufficiently unbalanced, too much closure of the vertebrae LV4 in the direction of LV5 against disc D (for example) can result, producing "pinching" by a stressed muscle group on one side of the spinal column and causing excess force on that side, which produces a tilting between the two vertebrae, resulting in pinching of a nerve.
Traditionally, physicians, chiropractors, and others have utilized traction in various attempts to stretch the spine and open the nutrient passages 2 and 3 to allow nutrient solution to diffuse into those regions and nourish the upper and lower surfaces of the disc D. However, during traction, the patient's back muscles remain stressed. Furthermore, during traction most of the traction forces put undue stress on other parts of the body, such as the neck, shoulders, and upper spine.
If all of the relevant muscles are relaxed, only approximately 10-20 pounds of traction between an upper vertebra such as LV4 and a lower adjacent one such as LV5 of FIG. 1 is required to widen the "gap 10" a millimeter or two to relieve nerve pinching and allow efficient diffusion of nutrient fluid into passages 2 and 3. If this condition is maintained for at least half an hour, sufficient nutrient fluid will diffuse through passages 2 and 3 to nourish the upper and lower surfaces of disc D and the adjacent vertebrae surfaces, preventing premature dying of disc tissue and thus preventing the resulting thinning of the disc, decreasing of the gap 10, and pinching of the nerve N4, thereby relieving the resulting lower back pain.
Increased muscular tonicity from stress, pain, or constant pressure increases the strength of contraction of paralumbar muscles. This increases the hydrostatic pressure within the disc, forcing fluids and nutrients out, and prevents replacements thereof from entering. Disc nourishment normally occurs during sleep. Only minor increases in the pressure within the disc passages 2 and 3 will prevent it from being replenished with nutrient fluids. If the "relative pressure" within regions 2 and 3 for a person lying at rest is considered to be equal to 1, and if the person sits up, this raises the relative pressure to a value of 6. If the person then lifts a 20 pound package, the relative pressure is raised to a value of 20. Acting as an elastic tissue, the disc absorbs all of the extra pressure due to its shock-absorbing design, as long as it remains elastic. However, discs which lose a substantial amount of surface tissue due to dying of cells or lose disc contents (nucleus pulposus), do not remain elastic.
Further experimentation with the structure described with regard to FIGS. 5, 6, and 7 herein and in the above-identified copending parent application has shown that 20 pounds of traction weight is not essential to provide the traction needed across the sacro-iliac joints and the lumbar spine and the upper thoracic spine to allow efficient diffusion of nutrient fluid through passages 2 and 3 to nourish the disc. My further experimentation also has shown that some patients suffer from tiring of their neck muscles when using the structure of FIGS. 5, 6, and 7. For some patients the stress of carrying the twenty pound weight belts and the fully inflated floatation tube 20 prior to entering the water is unsatisfactory. My experiments also have indicated a need for longer periods of therapy in the water than previously thought necessary.
U.S. Pat. No. 4,722,329 discloses an apparatus for supporting a patient in water utilizing an overhead member supported by floatation. A connection around the supported person by means of a tight vest keeps the person's shoulder and head above the surface of the water. A weight belt is applied to the patient's hips, to apply tension to the person's neck. This reference has the shortcoming that the disclosed device does not allow adequate movement of the upper body, does not provide support for the person's arms, restricts the patient's breathing, and fails to emphasize the need to relax the patient's muscles extending from the sacrum and pelvis up to the patient's chest. This prevents the patient from executing a good range of symmetrical, muscle-relaxing exercises which are important to achieving the benefits of the traction that the apparatus of U.S. Pat. No. 4,722,329 is attempting to achieve. Furthermore, the device is difficult for the user to put on without help. The user probably needs to be in the water to put the apparatus of U.S. Pat. No. 4,722,329 on. The device of U.S. Pat. No. 4,722,329 does not provide a "counter traction" platform to enable the user to bend and flex or extend the spine while using the device.
There is an unmet need for an improved apparatus and method for rehydrating desiccated lumbar intervertebral discs and relieving low back pain and stress without the shortcomings of prior traction techniques and apparatus, yet provides mild, prescribed symmetrical traction, proper body temperature, mild body massaging, avoids constriction of breathing, avoids pinching of armpit nerves, and allows flexion, extension, and bending exercises for the low back with "negative" weight bearing on the lumbar spine. There is a further need for equipment and a technique for providing these benefits to stroke victims and other patients with significant neuromuscular impairments and to partially rehabilitate previously disabled muscles.